Effectiveness of dexamethasone iontophoresis for temporomandibular joint involvement in juvenile idiopathic arthritis

Abstract

Objective Temporomandibular joint (TMJ) involvement is common in Juvenile Idiopathic Arthritis (JIA). Dexamethasone iontophoresis (DIP) uses low-grade electric currents for transdermal dexamethasone delivery into deeper anatomic structures. The purpose of this study was to assess the safety and effectiveness of DIP for the treatment of TMJ involvement in JIA, and to delineate variables that are associated with improvement after DIP. Methods Medical records of all JIA patients who underwent DIP for TMJ involvement at a larger tertiary pediatric rheumatology center from 1997 to 2011 were reviewed. DIP was performed using a standard protocol. The effectiveness of DIP was assessed by comparing the maximal inter-incisor opening (MIOTMJ) and the maximal lateral excursion (MLETMJ) before and after treatment. Results Twenty-eight patients (ages 2– 21 years) who received an average of eight DIP treatment sessions per involved TMJ were included in the analysis. Statistically significant improvement in the median MIOTMJ (p< 0.0001) was observed in 68%. The median MLETMJ (p= 0.03) improved in 69%, and resolution of TMJ pain occurred in 73% of the patients who had TMJ pain at baseline. Side effects of DIP were transient site erythema (86%), skin blister (4%), and metallic taste (4%). Improvement in TMJ range of motion from DIP is associated with lower MIOTMJ, lower MLETMJ, and absence of TMJ crepitus at baseline. Conclusion In this pilot study DIP appeared to be an effective and safe initial treatment of TMJ involvement in JIA, especially among patients with decreased TMJ measurements. Prospective controlled studies are needed.

Temporomandibular disorders. Part 2: conservative management

“…Pain did not improve and side effects ranged from transient erythema (86%) to metallic taste (4%) and blistering (4%). 67 Another study found that dexamethasone applied to the TMJ can help improve function but does not reduce pain. 68 Other investigations have shown that iontophoresis with dexamethasone is no more effective than a saline placebo in providing pain relief for patients with TMD.…”

Imaging of the Temporomandibular Joint in Juvenile Idiopathic Arthritis

“…The hope is that early aggressive therapy of TMJ arthritis in children with JIA will help to prevent progressive destructive disease. Several groups have reported benefit of the use of intraarticular () and transcutaneous () long‐acting corticosteroids for treating TMJ arthritis in children with JIA, and more recently intraarticular infliximab has been explored in cases of refractory TMJ arthritis (). Measuring the benefit of therapy for TMJ arthritis in children with JIA has relied on mouth opening distances, patient‐reported pain and function, and MRI findings ().…”

Effective use of transdermal drug delivery in children

“…The study involved 28 (2-21 y) JIA patients, most of whom completed the 8-10 iontophoresis sessions. Approximately 2/3 of the subjects experienced an improvement or a normalization of the temporomandibular joint range of motion and the associated pain [167]. While this small study suggests that dexamethasone iontophoresis is safe and effective, further studies are required to determine the optimum dosing and to compare iontophoresis with intra-articular steroid injections.…”

“…The iontophoresis of dexamethasone phosphate, a common procedure in physiotherapy, was recently tested for the treatment of temporomandibular joint involvement in juvenile idiopathic arthritis (JIA) as a less invasive alternative to intra-articular steroid injections [167]. The study involved 28 (2-21 y) JIA patients, most of whom completed the 8-10 iontophoresis sessions.…”